Currently, if you live in an Independent First Nations Alliance (IFNA) member community, you can’t have a midwife attended birth. Why? Because there aren’t any midwives. This reality represents a tremendous loss - midwives have been ushering new life into Indigenous communities for millennia. Colonization played a significant role in the decline of Traditional Birth Practices through policies that eliminated Indigenous midwifery in favor of the biomedical model of care.1 The loss of traditional birth practices has had profound physical, cultural, and spiritual implications for Indigenous communities.2  

What is IFNA?

The Independent First Nations Alliance is a Tribal Council supporting five communities in northwestern Ontario: Whitesand First Nation, Lac Seul First Nation, Kitchenuhmaykoosib Inninuwug, Pikangikum First Nation and Muskrat Dam First Nation. Three of the five are fly-in communities. The remoteness of the communities presents some unique healthcare challenges.

Connor Howie, IFNA’s Director of Health Services, says a number of adverse pregnancy outcomes in the communities highlighted care gaps. The team wondered if reintegrating midwifery into the communities might help close these gaps. IFNA applied for and was awarded a Community Readiness Grant (CRG) which provides funding to increase awareness of midwifery care and to assess community readiness for an Indigenous Midwifery Program.

Indigenous Midwifery Programs

Indigenous Midwifery Programs (IMPs) provide midwifery services to First Nations and urban, rural, and northern Indigenous communities, through:

  • Culturally safe prenatal, intrapartum, post-partum care;
  • Programs and services to support youth and expectant families (e.g. parenting classes, breastfeeding support); and,
  • Community education to support youth and expectant families to make informed choices around reproductive health.

In Ontario, Indigenous midwives can work under an exception clause in the Midwifery Act, 1991, with the title of Aboriginal Midwife.3 The exception clause in the Act allows for a community to formally recognize those who hold the skills and knowledge to provide midwifery care as legal midwives; Ontario is the only province with an exemption clause built into the midwifery legislation.4

In this model, Indigenous midwives are accountable to standards set by their Nations and are educated through community or Nation-based learning methods (i.e. local training programs or apprenticeships). Currently, there are less than a dozen Indigenous midwives practicing under exemption in Ontario. But advocates are working hard to increase this number.

In-depth Consultation Process

As part of the community readiness assessment, IFNA collected both quantitative and qualitative data. IFNA requested data from BORN Ontario to help understand the health status and outcomes of pregnant individuals and infants in their communities.  Health interventions were also part of the dataset. BORN provided information about prenatal education, antenatal care, postpartum complications, NICU admissions, labour and birth. The data was reviewed, interpreted, and then shared with IFNA communities in the form of an infographic, as well as with the Ministry of Health, by way of narrative report, at the culmination of the assessment. Connor says he appreciated the opportunity to partner with BORN and use the data to support their work.

In addition to analysing data, the IFNA team also engaged community members to understand the historical context of midwifery and current healthcare priorities. Charlotte Oades is an IFNA Registered Nurse and took a lead in the community readiness assessment. She says hearing traditional stories and elder testimonials was invaluable, especially because these stories are lost when knowledge holders pass away. And many have.

The people Charlotte spoke to explained that midwifery had been part of their communities for hundreds of years “long before any government said it wasn’t safe.” Midwives were known to be very capable practitioners. Charlotte says “Midwives were experts and well-respected pillars of their community. It seems that outsider perspectives are what removed the validity of their knowledge”.

Betty5 - a member of Lac Seul First Nation – knows what it’s like to be disempowered. Betty used to deliver babies; she was competent, respected and trusted. She even delivered a baby in a boat (when a pregnant individual was traveling from Lac Seul to the Sioux Lookout hospital but gave birth before arriving). Betty* was there to help the baby safely pass from the spiritual world into the physical world. But now Betty* can no longer deliver babies; it isn’t within her scope and she is “only trusted to take vital signs”.

Is there an alternative for people like Betty? David De La Fosse, IFNA Clinical Manager, says they’re exploring pathways for community members to become Indigenous midwives: “We aren’t necessarily looking at the traditional western academic pathway where you go to university and get a degree. It’s more about lived experience and community training. This pathway already exists [IMP], it's about bringing it to our communities”. The community readiness assessment is the first step in making this happen.

Birth Evacuation

Pregnant individuals in IFNA communities are typically transported to Sioux Lookout, Winnipeg or Thunder Bay at 36 weeks gestation (and earlier if considered a high risk pregnancy) and stay in these urban centres until they give birth. This phenomenon, known as “forced evacuation for birth” or “confinement”, is the result of longstanding federal health policy and has been associated with many negative impacts.

The separation of families has significant impacts. David says non-insured health benefits (NIHB) may cover one person (called an escort) to accompany the pregnant person, but problems still arise as many individuals have children at home. David explains: “Leaving your children at home for potentially 6, 7 or even 8 weeks with limited childcare is not sustainable.” In some cases, David says individuals end up giving birth in the community without the necessary resources because they didn’t want to travel.

In more than one instance, a pregnant individual who was evacuated without an escort arrived at the hospital and received devastating news about the baby. At one of the most vulnerable points in their lives, they were alone. Charlotte describes evacuation as a severing: “It's a severing from home, family, and lineage”.

The Path Forward

Connor Howie says the community has expressed support for restoring traditional Indigenous midwifery: “It was quite moving to see that kind of energy, that kind of passion, that happiness when they [community members] were sharing stories. Older women talked about shadowing their grandmother or their mother as a midwife and their job was to just stand there and observe. And then, at a certain point, they would be able to step in and be a little more hands-on and little more hands-on... It was a life-long learning process.”

Charlotte says the indigenous midwifery role encompasses much more than just the birth itself: “An Indigenous midwife is a prenatal nutrition educator, a mental health supporter, a parenting educator, a breastfeeding educator, and a well-baby care provider. There's so much more to the role than simply delivering the child”.

Charlotte describes a common thread woven through her conversations with community members: “They really feel that birth and the journey into life and parenting is sacred and foundational - it knits lives together.” Reclaiming birth through Indigenous midwifery is a part of healing. Many feel that Indigenous Midwifery is key to the regeneration of strong Indigenous families. BORN is proud to play a small part in supporting this important decolonizing work of returning birth to communities.6

DID YOU KNOW... Organizations such as the Association of Ontario Midwives (AOM), the National Council of Indigenous Midwives NCIM, and midwifery researchers have been at the forefront of this decolonization work for decades and actively support communities to reclaim Indigenous midwifery? Check out the great resources below: